In this paper we outline the context of pregnant women’s lives and the plural health systems they
encounter in Koppal, the most deprived district in the state of Karnataka, south India. We combine
preliminary survey findings with qualitative work to illustrate the dynamics involved in seeking and
receiving obstetric care. Despite high levels of poverty and scarce resources supporting primary health
care in the region, women with obstetric complications do access a range of health providers. Yet they still
die. Although addressing the technical and managerial capacity constraints to ensuring equitable access to
emergency obstetric care is essential, we argue that maternal well-being and survival cannot be effectively
ensured without confronting the gender biases that also constrain health systems from supporting
women’s health and saving women’s lives. We analyse these biases as failures in acknowledgement and
accountability for pregnant women’s needs and conclude with strategic steps to effectively respond to the
situation that encompass technical, managerial and political action.
Keywords: maternal health, maternal mortality, plural health systems, gender bias, acknowledgement,
accountability.